Dermatologist’s Advice for the Best Skin Care during Chemotherapy

Cynthia Bailey, MD|October 22, 2013

It goes without saying that chemotherapy treatment is hard on your body, including your skin. As a dermatologist who is currently undergoing a series of very strong chemotherapy treatments for breast cancer, I’m a living laboratory of personal chemotherapy experience. I want to share what I've learned in the hope that it will help other cancer patients have a more comfortable chemotherapy experience.  On chemotherapy you can expect your skin to become drier and more fragile than ever before. Your nails may become brittle, your skin and nails may become discolored from the medicines you are receiving, and you may even be more sun sensitive from them too. If you take good care of your skin when you are on chemotherapy it’s possible to have soft, healthy, comfortable, and attractive skin throughout your treatment process.  Even more important, healthy skin is essential for your physical well-being during this difficult time. Dry, sensitive skin is prone to eczema, itching and sores that can become infected. Remember, your skin is a huge organ. It’s exposed to the germs and chemicals of the outside world. When you are undergoing chemotherapy, your immune system is suppressed and you are more vulnerable than ever before - which means you need healthy skin to protect you. What’s the best way to keep your skin healthy during chemotherapy? The most effective way to keep your skin healthy during chemotherapy is to diligently treat your skin to a hydrating gentle skin care routine every day. Your skin can only be hydrated from the outside. Don’t be tricked into thinking that drinking the requisite three quarts of water a day that your oncologist mandates during chemo will hydrate your skin. It can’t do that anymore than taking a bath can quench your thirst! The inside and outside of your body are separate and you have to use your skin care routine to hydrate your skin. What are the essential steps for a truly effective hydrating skin care routine: one that will take good care of your skin during your chemotherapy treatments? There are four key skin care steps you should follow daily during your chemotherapy:

  1. Use only gentle cleansers on your skin.
  2. Use only hypoallergenic products (those that don’t have a lot of fragrances, complex and taunting preservatives, or irritating ingredients) on your skin.
  3. Use warm, not steamy hot, water on your skin when your skin is suffering from dryness.
  4. Always apply a deeply hydrating moisturizer right after toweling dry.

The Details: Step 1: Limit your skin cleansers to those that are gentle and use them only where you need them. Be sure to always rinse them off your skin thoroughly with warm water Use only gentle cleansers that don’t strip your skin's natural oils, which leads to a breakdown of your skin’s fragile outer barrier called the stratum corneum. When you take skin with a weakened stratum corneum out into the world, it can’t hold up! Switch your cleansers right now to support your skin’s new fragility. Even with gentle cleansers, you need to be sure not to over-clean your skin and you need to rinse them off thoroughly.

  • For your body that usually means lathering up only the parts of your skin that have the body odor glands (you know where they are!), including your armpits, groin, buttocks, and feet. If you have oily skin, you also need to use cleanser on the oily areas of your back, neck, and chest.
  • For your face use the mildest cleanser that does the job. Don’t shoot for that tight "squeaky clean" feeling after washing because that means that you removed too much of your natural oils and actually irritated your skin. 
  • For your hands it means using cleanser only on your palms most of the time; the skin on the back of your hand rarely gets into germs and grime, and it’s so much more fragile and prone to dryness. Also, rinse all of the cleanser out from between your fingers where “dish pan hands” (aka irritant hand dermatitis) usually starts because of retained soap residue.

What are my favorite gentle cleansers and/or the ones that I’m using during my chemotherapy treatment? These are a combination of my products and products that can be purchased from other online retailers, local pharmacies, or Whole Foods stores. FACIAL CLEANSERS: Toleriane Cleanser is my personal favorite facial cleanser because it’s by far and away the gentlest cleanser I've ever found. I use it daily and have for years. It's serving me well during my chemo. Toleriane Cleanser, dermatologist's recommended facial cleanser for chemotherapyNeutrogena Extra Gentle Cleanser is another mild, non-medicated cleanser. GENERAL FACE, BODY AND HAND SKIN CLEANSERS: Glycerin-based bar soaps, such as Whole Food’s 365 Brand glycerin bar and Clearly Natural glycerin bar soap, are safe bets.  L'Occitane Shea Butter Extra Gentle Soap is gentle on skin as well. VaniCream Cleansing Bar is widely recommended by dermatologists as a trusted hypoallergenic and affordable general purpose bar cleanser. Vanicream Soap online Dr. Cynthia Bailey Skin Care Naturally Best Bar Soap for Dry Skin  is a simple product that I love. It's a completely natural and hypoallergenic bar soap that's made from organic ingredients. It’s also very affordable and a totally green all-purpose skin cleanser. Like all naturally made soaps it performs best if you have soft water. (I don’t recommend it if your water is hard.) naturally best bar soap for chemotherapy GENTLE HAND CLEANSERS: Because it's important that you wash your hands numerous times during the day, your hand skin is extremely susceptible to dryness and eczema. You MUST avoid harsh hand cleansers and most definitely do not use dish washing soap to wash your hands when you are in the kitchen. To clean your hands without drying out the skin keep a pump bottle of a gentle liquid hand soap with a foamer at every sink. The foamer allows you to clean your hands well with less soap. Because it rinses off better than a thicker cleanser, you avoid the risk of soap residue remaining on your skin to cause irritation. You’ll be surprised how much this simple step prevents the chapping of your hands. Remember, keep your skin care products hypoallergenic. That means avoid hand cleansers that are loaded with “extra” ingredients like fragrances - these are potential allergens. I'm also not a big fan of anti-bacterial ingredients because they can be irritating. I prefer a good hand washing with a gentle foaming cleanser. I've tried many natural foaming hand cleansers and my favorite is my All Natural Foaming Liquid Hand Soap, which is why I sell on my site. It’s all natural, hypoallergenic, does NOT contain potentially problematic fragrance, and allows me to wash my hands all day long without creating dryness. If I’m stuck somewhere and forced to use a different hand cleanser I notice the dryness almost immediately. Vermont Unscented Hand Soap Step 2: Use hypoallergenic skin care products only. During chemotherapy, your dry and fragile skin is more sensitive, so products you may have tolerated for years may now be wrong for your skin. Play it safe and use only gentle, hypoallergenic products when you are on chemo. All the cleansers I mentioned above and the moisturizers I’m about to mention are hypoallergenic. That means they don’t have taunting ingredients that are potential allergens or irritants for your fragile skin. Step 3: Bathe and wash your skin in a way that hydrates it instead of dries it out. There is controversy among dermatologists and other skin care experts as to whether bathing is drying for skin. I’m sure you've seen the recommendation to limit bathing to 5 minutes or less. I disagree! When your skin is immersed or covered with water it soaks it up, which is the essence of skin hydration. There are two important tricks to making your bath therapeutically hydrating. First, don’t strip your natural skin oils with hot water (remember that hot water cleans greasy dishes better than warm water). Second, trap the water your skin soaks up during your bath or shower by applying a really good moisturizer within three minutes after toweling dry to prevent evaporation of the precious water your skin just soaked up. This is how I care for my extremely sensitive and dryness-prone skin and it's worked for years, including now that I'm on chemotherapy.  It's the same recommendations I give to my sensitive-skin patients and it works 100% of the time in my practice. Step 4: Every day you need to apply moisturizer to your skin within three minutes after washing!

  • For your body that means after every bath or shower (you may be able to skip your trunk if it’s not too dry).
  • For your face that means morning and night after washing.
  • For your hands that means many times during the day so keep a moisturizer by every sink.
  • For your lips it means coating them throughout the day with a hydrating lip balm.

What are the best moisturizers for your skin while you’re being treated with chemotherapy? Use only moisturizers with rich oils and water-binding ingredients that soak deeply into your skin. This keeps you from feeling greasy after applying them and it keeps them from soiling your clothes. Remember, moisturizers only work if they are applied right after you've had your skin in water. This is because they don’t moisturize; they trap the water that you just soaked up into your skin while your skin is wet…. this means within three minutes of toweling dry. Hypoallergenic and Deeply Hydrating Moisturizers The products I'm absolutely depending on during my chemotherapy are listed below; they feel great and are working beautifully for me, for which I'm grateful. My All Natural Face and Body Lotion: I love this rich and soothing lotion and use it from face to toes. The fact that it’s a single product skin care step is great when I feel tired from my chemo treatments and don't have the energy for complex anything. All Natural Face, Hand and Body Lotion for chemotherapy skin problems I always use my Green Tea Antioxidant Skin Therapy morning and night on my face. The hyaluronic acid is a great skin hydrator and the antioxidants have so many benefits, which I outline on the product web page. I apply it before my Natural Lotion. dermatologist recommended Green Tea Antioxidant Skin Therapy These two products (along with zinc oxide sunscreen) are the ones I'm never without and always pack when I travel. I was also recently gifted a lovely boutique oil-based ointment made by our local Matanzas Creek Winery. It’s a blend of grape seed oil and macadamia oil and I use it on the irritated areas of my skin that are still suffering from surgical tape, which my skin hates. Any rich oil or ointment would work as well including Jojoba Oil, Shea Butter, or even Vaseline. To prevent hand chapping caused by washing my hands all day, I use my Dry Skin Hand Cream because the glycerin-rich formula hydrates without ever leaving my palms feeling greasy. I keep it by my kitchen sink and apply it often after washing. Dry Skin Hand Cream Other options for richly hydrating oils or moisturizing creams include: Dr. Hauschka’s Rose Cream, a richly hydrating natural skin care moisturizer; Jojoba Oil, the active ingredient in most moisturizers is just the oil and you can get right to the point by using jojoba, which is excellent skin moisturizing oil; Clearly Natural Glycerin Body Lotion, I would recommend the unscented version.  Additional products include: Vani Cream, a hypoallergenic moisturizer popular with dermatologists. buy dermatologist recommended vanicream onlineBag Balm, severely chapped hands benefit from a night time treatment of Bag Balm; soak your hands for five minutes or more in warm water (e.g. take a shower or bath or do the dishes), apply Bag Balm, and cover with cotton gloves for at least 30 minutes and ideally overnight. This same treatment is good for the dry and brittle fingernails and cuticles from chemo treatments. For this problem, Bag Balm can also be applied many times during the day after water contact. buy Bag Balm 1 oz My Dry Skin Hand Kit comes with Bag Balm, Vermont Foaming Hand Soap, my Dry Skin Hand Cream, and the best fitting pair of therapeutic cotton gloves.Dry Hand Skin Repair Kit Lip Balms Remember to use a richly hydrating lip balm because chemo causes dry and chapped lips too. Avoid the seductive "healing lip balm" ingredients that often get you addicted to lip balm; these ingredients can actually chap your lips, leaving your running for more lip balm. I recommend using lip balms made from only the active moisturizing ingredients such as shea butter, petrolatum, and/or glycerin. The lip products I recommend and use are: Ceralip, in a handy tube that is easy to take with you and use all day; Ceralip L’Occitane Shea Butter Lip Balm Stick; EltaMD UV Lip Balm SPF 31, my favorite lip sunscreen in a deeply hydrating and pleasant tasting balm. buy Elta Lip Balm SPF 31 online Chemo is no picnic but you (we) can make yourself more comfortable when you know how to counter the side effects. In upcoming posts, I'll tell you what I've learned about some of the other skin "misadventures" in my living chemo laboratory. Skin issues such as:

  • The prevention of skin infections
  • Soothing dryness of the eyes and nose
  • Sun sensitivity from chemo medicines
  • Discoloration of skin and nails
  • Countering skin paleness from anemia and general lack of vitality during chemo
  • Personal experience with fighting chemo hair loss with cold caps
  • What we can do to look our best during chemo with anti-aging skin care products and treatments

If you would like to know more about my breast cancer story please read my post titled Breast Cancer Awareness Hits Home For Me in 2013. Photo attribution: Thanks and gratitude to © Push Pictures/Corbis

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